Why are health insurance funds changing to different policy categories?

Health Fund Policy Changes were instigated by Australian Government reviews to help consumers better understand WHAT health insurance policy and exclusions really mean, allowing consumers to shop around more for coverage that suits them.

Your procedure may be subjected to stricter rebate limitations or fail to meet requirements and criteria for a Medicare rebate/MBS Item Code.

TIP: If you’re counting on using your Health Fund cover to help pay for your reconstructive or corrective plastic surgery procedure, such as a Breast Reduction or Rhinoplasty, you may want to ask your Insurance company what changes these new ranking systems will have on your existing policy.

Excerpt from the changes according to Australian Health Minister Greg Hunt’s media release:

For the first time I am proud to mandate vital support for women under the Silver and Bronze categories, which will include gynaecological services, ovarian and breast cancer treatment and breast reconstruction.

This will support thousands of Australian women through cancer diagnosis, treatment and recuperation.

Consumers should expect to see new insurance policies categorised under this new system by early 2019 from insurance companies.

Understanding Private Health Insurance Hospital Cover and related policy inclusions and exclusions can be very confusing, and the pending changes proposed by the Health Minister, coming into effect in early 2019, could greatly impact what Plastic Surgery procedures are eligible for cover.

What this means to patients:

The only way to assess your actual coverage is to have a Quote from your Surgeon with details of the surgery procedure code (if applicable). Then phone your Insurance Company, such as BUPA, Medibank, AAMI or Australian Unity, for actual clarification.

** Please note that this information is general in nature, and is a synopsis of selected information available from news outlets and insurance firms.

More INFO: Health Fund Coverage Complaints for Hospitalisation Exclusions, New Classifications in 2019

GET your documents in order (your Policy, your notes about the surgery including the Medicare ITEM Number that your Surgeon has told you applies to your condition, your original referral from your GP, any accompanying documentation, scans, or images you have, along with your Surgeon’s notes and Estimates/Quote).

Other paperwork may also be required so be patient, and be prepared.

Find a comfortable spot to be on the phone for some time (and allow adequate time – don’t try to squish in a call to your health fund during a 30 minute office break)!

Contact your health fund directly, by phone, with all of your documents in order.

What to DO first, and what to HAVE in front of you, before you phone your private health fund to see what coverage you have in relation to your plastic surgery procedure.

Grab a coffee or snack and a fully charged phone

Allow at least an hour for the conversation (don’t try to squeeze it in on a short break from the office)

Put your feet up and plan to spend some time on hold (or maybe get out the nail polish while you wait)

Consider the possibility you may be given different or inaccurate information each time you call.

Ask for a reference number or name of person you speak to.

Some patients found it helpful to telephone their health insurance company on two separate occasions, to check what they’ve been told is covered, with different representatives, JUST to verify the information they’ve been given was correct.

This blog, originally published in early 2018 and updated last 28 November 2018.

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Phone us on (03) 8849 1444 if you need a copy of your original quote from your consultation with a Plastic Surgeon, or for our GUIDE on Medicare and Health Insurance and Plastic Surgery (or send an enquiry, below).

Dr Geoff Barnett - MBBS, FRACS (Plast) Dr Geoffrey Barnett, FRACS (Plas) is a Melbourne based Specialist Plastic Surgeon who has over 35 years of expertise in Plastic & Reconstructive Surgeon for Cosmetic Surgery, Plastic Surgery and Body Contouring Surgery after Bariatric Surgery.Qualifications and Memberships: Specialist Plastic Surgeon (FRACS) Member - Fellowship of the Royal Australasian College of Surgeons in Plastic and Reconstructive Surgery [FRACS (Plast).The Royal Australasian College of Surgeons (RACS) is the only professional body recognised by the Australian Medical Council (AMC) and the Medical Council of New Zealand (MCNZ) to train Surgeons in Australia and New Zealand.Author BIO page: https://plasticsurgeons.com.au/dr-geoff-barnett/

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This website is owned and operated by CocoMedical Pty Ltd. ABN 60074912075. Trading as Cosmetic Surgery for Women & Men. Medical Director – Dr Craig Rubinstein MBBS, FRACS, ASPS, ASAPS, ISAPS. Registered Address: 759 Burwood Rd, Hawthorn East 3123, Melbourne, Australia. *General Disclaimer – Results depend on individual patient circumstances and can vary significantly. Results may also be impacted by a variety of factors including your lifestyle, weight, nutritional intake and overall health. Consult your Specialist Plastic Surgeon for details. This information is general in nature and is not intended to be medical advice nor does it constitute a doctor-patient relationship. Surgery risks and complications will be covered in detail during a consultation with your Surgeon. *Photography Disclaimer – Unless our photograph(s) or image(s) are marked with a copyright signal and surgeon’s name or group name, they are licensed stock photography, not patients. For patient images, visit our Before and After Surgery Galleries. Note that results can vary from patient to patient and that all invasive surgery carries risks. Be sure you do your research before proceeding.